Even before we ever got pregnant, I had a feeling breastfeeding might not be in the cards for me. I knew so many people who had wanted desperately to breastfeed their kids, but for whom it hadn’t worked out. I fully understand that breast milk is the best milk for babies, especially preemies. I always wanted very much to be able to breastfeed my own babies, but I knew it wasn’t a guaranteed thing, and I knew there was no shame if, for whatever reason, it didn’t work out.
And it didn’t work out. For many reasons. I don’t feel guilt from society about it, because I know it was the best decision for our family. But I feel deeply sad about it. I grieve not being able to give that to my baby boy. Even as I write this my eyes are welling up with tears. I think it’s something I will always be sad about, even though as soon as we made the decision I was overcome with intense relief and a great sense of freedom.
Everyone’s story about how and why they choose to feed their babies a certain way is different and intensely personal. I don’t pretend to know what’s best for everyone, and I’m not looking for validation or trying to justify myself and I’m certainly not looking for “why didn’t you try ____?” Or “so and so did this and it worked out fine.” I’m simply sharing my journey, and hoping that maybe it resonates with someone else out there who had a similar experience, and that maybe they don’t feel quite as alone in their grief.
There are a few things I wish I had known about breastfeeding beforehand. I had started an online breastfeeding class the day before my water broke, but had been planning on spreading it out over a few days to help keep me occupied over the next three weeks HAHA. This class didn’t cover in any sort of detail the things I wish I had known, and I don’t know that these would have been covered in a typical breastfeeding class (and I would be interested to hear from someone who has taken a class or read a book if this information was covered!)
What I wish I had known:
—I always knew I would need to pump when I returned to work, but I never thought I would have to pump before I even tried to actually breastfeed! Maybe that was naive. When you have a C-section, especially one significantly earlier than your due date, it takes longer for your milk to come in. I knew that, but I never realized that I would have to pump on a full feeding schedule in order for my milk to come in,
—or that the first few days hardly anything would be produced and that would make me feel like I was going through the motions of a really uncomfortable and mechanical process for what felt like nothing,
—or that preemies (especially boys) take longer to learn to breastfeed because it wears them out much more than bottle-feeding. Since they are already working harder to perform basic bodily functions like maintaining body temperature and breathing, they don’t always have the energy required to work for their food. Even if they latch and suckle successfully, they are often still not consuming as much as they need.
—Lactation consultants will manhandle you. It is not weird for them because it’s their job. But it’s okay if it’s weird for you. Because it is weird. Necessary at times in order to instruct. But weird. And uncomfortable.
—While learning to breastfeed in the hospital, you will likely need to just take your shirt off and be exposed to the lactation people and the nurses, and any doctors who happen to pop in during that time. Again, not weird for them, but maybe for you.
—I’ve heard it said frequently that very few women are actually not able to produce enough milk. What I never heard said was how hard some women have to work in order to be able to produce that milk! And that’s hard work on top of recovering from labor and/or surgery and taking care of a tiny, vulnerable, helpless person in addition to herself.
Maybe if I had known more of these things ahead of time (especially since it was likely my son was going to come early so all the preemie/milk coming in later stuff would likely apply to me) I would have been more mentally prepared to take on the challenge. Maybe.
In any case, I knew none of that and was just thankful that I was able to have skin-to-skin bonding with my baby directly after my emergency C-section. I know that is not something everyone has the opportunity to do, especially with a preterm baby. His nurse said his blood sugar was a little low and asked if it would be okay to give him formula when she got him back to the special care unit, even though she knew I was planning to breastfeed. My husband and I both immediately responded yes, by all means if he needs formula, give it to him. We had known our little guy would probably need supplementation since he had arrived early, and we were just fine with that.
While we were enjoying those first quiet moments with our son, the lactation nurse arrived. She was very nice, but began spewing a LOT of information and manhandling me and my son, all while my brain was still spinning from the anesthesia, the whirlwind of the day’s events, and the fact that the little person in my arms had only hours ago been kicking the insides of my belly. Needless to say, I did not retain much information.
The gist I got from her was that every drop of colostrum (the thick, early breast milk) would be beneficial to our baby, I have inverted nipples which would make it more difficult for the baby to latch but not impossible, and that I would need to start pumping 8-12 times a day starting now.
After my son was taken away to the special care unit, she got me started with a hospital pump. She tried to get my husband involved, and I could tell by the look on his face that he was as overwhelmed and uncomfortable as I was. Watching the doctors cut me open and pull my insides out of my body was not a problem for him, but this was. Truly, it was an uncomfortable, awkward, and mechanical process that after 15 minutes or so yielded one whole drop. I had always imagined that breastfeeding would be a sweet, intimate experience, but so far I felt like a tired, manipulated cow.
I finally expressed to everyone that I was feeling lightheaded and she got the hint that it was time for her to go. She urged me to pump every few hours the rest of the day, but I could take a 5 hour break at night.
Not long after she left, I got sick to my stomach, and as my nurse hooked me up with some lovely anti-nausea medicine to help knock me out so I could get some sleep, she told me not to worry so much about pumping today. “They always try to get you pumping right away, but you have to take care of yourself. You just had surgery, and you need to rest! As long as you pump once more before you go to bed, you can start fresh tomorrow.”
I was relieved by her words and pumped one more time that night, with no results. Annoyed and tired and confused, I then didn’t have the energy in me to go down to the special care unit that night to see my baby which was very hard for me. My husband went to see him saying, “No offense, but I’d rather be with him.” I totally agreed. Our baby needed at least one of us!
The next day, I knew I needed to get on a pumping schedule, but I wasn’t really sure how to start. The lactation nurse’s information from the day before was too much for my overwhelmed brain to retain much. Also, I had bigger problems, like getting up out of bed to go to the bathroom (ow), and trying to push past the pain and discomfort in my body to go down the hall and see my baby.
The lactation nurse came back around that afternoon and I confessed that I had only pumped one more time since seeing her 24 hours ago. She seemed somewhat concerned but said, “That’s okay. We can get you on a schedule now and you should be able to catch back up.”
Thus began my schedule of pumping for 15 minutes or so every 2-3 hours. After each pumping session, I had to wash and dry all of the pump parts, which added another 15 minutes of time. Because I was moving so slowly while recovering from my surgery, it was difficult for me to manage basic bodily functions (going to the bathroom, eating food, adjusting my position in bed, getting dressed, etc.) much less pumping. And any tiny bit of spare time I had I wanted to spend with my son, who, you know, this was all about anyway. But it was exhausting, so more often than I wanted, I had to send my husband off to be with him during his care times, while I sat like a cow, pumping with no results.
It slowly got easier. I forced myself to move around more and tried to ignore the pain and discomfort so that I could spend more time with my baby. I started to slowly see results from the pumping, as all the nurses had assured me I would. I was so relieved that I had something to offer my baby, and I felt a renewed sense of hope that this would work out for us.
When he was a few days old, the lactation nurse helped us as we tried to get him to latch for the first time. I was degraded to feeling like a high school freshman again as the flatness of my breasts was discussed. Because of my inverted nipples and my little guy’s little mouth, it was basically going to be impossible—at least in the beginning—without a nipple shield. An awkward silicone nipple shield was placed on me, and we attempted nursing.
My baby boy did well, though he did appear to get worn out quickly. I was encouraged to try feeding him for a few minutes a couple times a day before his bottle. Sometimes he did better than others. One time when he was not very interested, I urged him gently to bear with me and just try and then he could have his “real food.” My husband immediately told me gently but firmly, “Stop. Don’t go down that path.” My eyes welled with tears. He was right—that sort of negative thinking wasn’t going to help the situation.
When I was discharged on the fourth day, I was allowed to remain in my room and keep using the hospital grade pump I was assigned. I took advantage of my 5 hour pumping breaks at night, but every morning, I wheeled my pump down the hall to my baby’s room and parked myself there for most of the day. At least I was able to be near him, even though I had to pump frequently which cut into my time being able to hold him.
By day five I saw a significant increase in my milk supply. I finally felt a renewed sense of hope amid all the stress, but it was short lived. The stress was getting to me, especially now that my husband was only around in the evenings. During the days, I spent as much time in our boy’s room as I could, but I was tired of pumping, tired of having to hold him on a leash of monitors, tired of having to hobble around the rest of the hospital when I needed to eat, get water, or go to the bathroom (which is a whole unpleasant experience of its own after a C-section!), tired of not knowing when we could take him home.
I told the lactation consultant that I had had a very successful day on day five, but that I was no longer seeing those same results. She told me stress could affect it, that I was doing everything right, and that every drop I could give my son was valuable.
By the time our baby boy was discharged from the hospital, we had a set plan that I would continue to pump and we would give him whatever I made then supplement with formula. It was at about half and half, but his appetite quickly grew and I wasn’t always able to keep up. The setup we had at home was not ideal. I was pumping in a room by myself, then washing the parts in the bathroom to save myself time from going downstairs at all hours of the day. (I’ve heard that some people will just put their pump parts in the refrigerator between sessions, but I was warned not to do this with a preemie, as the risk of bacteria growing is higher.) Between doing this eight times a day, eating, attempting to sleep, and trying to spend as much time as I could with my newborn son, I was at my wit’s end by the time we had his first doctor’s appointment a few days later. I felt sure that if I could just try breastfeeding that my body would respond by ramping up my supply.
Thankfully, his pediatrician said that he had gained enough weight that I could try to exclusively breastfeed. I was so relieved to finally have a chance to do that! What I didn’t realize was that I should continue pumping while making that transition. I didn’t realize that my baby would not only get worn out while nursing, but he would not have the strength to get as much milk as he needed. I didn’t realize that the nipple shield would help him latch, but that his latch would be shallow, resulting in even more restricted flow.
I realized too late that I should have made an appointment with the outpatient lactation consultants right away. Instead, I waited a few days and called only when I started to see several warning signs that my son was not getting enough milk, the most obvious and frightening one being his voraciously sucking on his hands after a long nursing session as if he were starving. The horrible fear crept in that maybe I was not able to feed my son.
We finally caved and supplemented formula in a bottle for him, and I made the appointment. The woman on the phone told me among other things, “You’re going to hate me for saying this, but you should still be pumping after every feed.”
It was a long, sleepless weekend while we waited for that appointmet, and we compiled our long list of questions that needed answered.
I was afraid that the lactation consultant would try to convince me in any possible way that I must breastfeed at all costs. Instead, one of the first questions she asked me was how I was dealing with pumping. I got all choked up as I answered honestly, “Not great.” She could see clearly that the pumping was breaking me, and she offered as much information as she could:
—Our son was only getting about 6-8 milliliters of milk in a 30 minute nursing session when he would frequently drink 60 out of a bottle (no wonder he was acting hungry!!). So we would need to continue to supplement from a bottle. From what I was pumping over the weekend, we would be supplementing more than half formula.
—The nipple shield was helping him latch, but again, the latch was shallow and he was not able to get much milk that way.
—The consultant showed me how to encourage him to latch without the shield by manhandling us both. It was exhausting for both baby and me, and though it eventually worked, I knew I would not have it in me to do that at every nursing session.
—I did in fact have a low supply, due probably to:
-the fact that it took us awhile to get pregnant indicated that I probably have a hormonal imbalance which would affect my supply
-the fact that I never should have gone more than 4 hours without pumping in the beginning
-I’d been using the nipple shield and not pumping so my body assumed I didn’t need nearly as much milk as I actually did.
There were things that I could do to try to increase my supply:
-pump longer and more frequently (?!)
-do 90 minutes of skin-to-skin daily (when will I have the time?!)
-only use the nipple shield after attempting to get him to latch without it 3 or 4 times (which would be both physically, mentally, and emotionally exhausting for both of us).
She laid out exactly what it would take to get us exclusively breastfeeding within 3-5 weeks, though even then he would still likely need a formula supplement. She offered all of this without ramming down my throat that “breast milk is the very best thing you can offer your child,” and that if I chose not to pursue it I would be denying my child his fullest potential.
Instead, she recognized that I had been through a really difficult pregnancy after trying for awhile to get pregnant, that I would have to return to work at some point in the next two months, and that perhaps I was tired and wouldn’t want to spend most of my maternity leave pumping on the off chance that I was able to produce enough milk eventually, only to have to return to work and pump some more. I think she really wanted to be able to offer me a simpler solution, but she acknowledged that this was the best chance we had, and I think she could see without judgment what I was about to decide.
When my husband came home from work, I laid out all the information for him. As I was talking, we both knew what our decision would be. For my mental and physical health, I could not keep pumping. As much as I wanted to offer my son my breast milk, I wanted to offer him my presence more. I couldn’t spend the first two months of his life miserable and exhausted and stressed out, especially if it ultimately wasn’t going to work out. After all we had done fighting to get him here alive and well, I didn’t have any fight left in my body to feed him, and I didn’t want to make him fight anymore either.
Sometimes I wonder how it could have been different—
Maybe if I had been more mentally prepared for what I would have to do to get my supply up.
Maybe if I hadn’t received mixed information in the beginning.
Maybe if I had had better results in the beginning and had been able to maintain that momentum.
Maybe if I hadn’t spent five weeks in the hospital.
Maybe if I had felt like I’d been able to bond with my baby more and better in the beginning.
Maybe if I hadn’t felt so much stress and anxiety throughout my pregnancy.
Maybe if our country offered an appropriately compensated amount of time for maternity and paternity leave rather than an ambiguous unpaid 12 weeks which hardly offers enough time for such a major life change, especially when fathers are not afforded as much time as mothers so mothers are often left to their own devices while still recovering.
Maybe if. . .
Maybe if. . .
But it doesn’t matter—we made the decision we did because of the way things played out. Because this crazy pregnancy during this crazy year was already more than I ever thought I could handle and now that my son is here, I just want to be with him. I don’t want to split my time with a machine and feel that I can’t enjoy my son. Maybe that sounds selfish, but it was also for him. He deserves a mom who is present and not on the brink of madness.
As soon as we made the decision to formula feed, we felt immediate and intense relief. My husband was glad he wouldn’t have to watch me struggle under the pressure anymore. I suddenly felt free in a way I hadn’t in a long time—honestly, since before I was pregnant. Not being chained to a pump meant I would have time (albeit very little time at least for several weeks) to go for walks. To take showers. To do some writing. To drink coffee. To enjoy snuggles with my son rather than always watching the clock until it was time to pump or feed again. I was free for the first time in months to live my life naturally rather than clinically.
I admire women who are able to exclusively pump for their babies. I am not one of those women. I admire women who are able to breastfeed, especially when they have to overcome major challenges or still supplement. I am not one of those women. I admire formula-feeding women like me, because we know our limits whether we like them or not. I will always be thankful that I was able to at least try breastfeeding, and always sad that I wasn’t able to give more breast milk to my son. I know how valuable it is, especially for preemies. But I also know that he is a tough cookie, I know my own limits, and I know that I will be able to feed him and love him better this way.
After we decided to switch to formula and I was weaning myself off the pump, I still cried every time I pumped as I watched my supply dry up completely. It was like my body was mourning this thing that it couldn’t properly do for the life it had carried and grown. I still cry every time he is upset and looks around at me to nurse for comfort. I still cry when his little belly gets upset from the formula. I’m crying right now just thinking about how I couldn’t do this for him, and wondering still: if I had tried harder, would I have been able to?
And then I remember all those nights in the hospital, with just the two of us, him kicking away in my belly and me wondering if we would even make it out alive. The fact that my inability to breastfeed him is the only thing out of this entire situation that I am grieving is absolutely a miracle. That doesn’t invalidate my feelings, but it helps me to reorient my point of view to one of intense gratitude. I am choosing to be grateful that I can feed my son, even if it’s not in the way I want to.
So to all you mamas out there who weren’t able to breastfeed or had to stop early for whatever reason, I see you. I feel your pain. And I trust that our kids will be just fine.